Observation Journal

I'm almost embarrassed to be posting this... for a class assignment, we have to write two journal entries in a very specific format regarding health and politics in Switzerland. These have to focus on interactive experiences, be as interactively written as possible, and basically the rules and requirements are utterly confusing and ridiculous. We also have to use the die format- first, simple description. Then, an interpretation that addresses possible meanings. And finally, an evaluation that provides my own insight. It still needs some work but anyway, here is my Swiss observation on health in la suisse. My evaluation needs some work but I don't really know what else to say at this point- i tend to like universal health care systems, but Switzerland has a tradition for doing things its own way and I respect that.


Introduction:
One morning, my colleagues and I were given a tour of the International Red Cross and Red Crescent Museum in Geneva Switzerland. My experiences at the Red Cross left me feeling emotionally vulnerable; the museum's visualizations and symbolic representation of tragedies tugged painfully at my heartstrings, yet I felt impatient for my own opportunities to positively affect the world. As I sat down to a dinner with my Swiss host family that night, the day's emotions and memories continued to pluck and pull at my consciousness, distracting me from the conversation. My attention was completely diverted, however, when my host sister Justine began describing her meeting with a health insurance representative earlier in the afternoon. I was shocked when Justine shared her monthly quote for basic health insurance, even more so when she explained that she had to pay extra for “luxuries” like a private room separate from vulnerable children and elderly. Our ensuing conversation spurred a question within me that forms the basic prompt for this journal entry: Is there a contradiction between the humanitarian reputation of Switzerland and the health care system?

Description:
Initial Observations and Ensuing Dialogs
Before coming to Switzerland, I was aware that the country was internationally recognized for its neutrality and its acceptance and promotion of humanitarianism. Not only do international organizations such as the United Nations and the World Trade Organizations have seats in Geneva, but also a plethora of non-governmental humanitarian groups. I also held a firm belief that the Swiss way was the best way, and that undoubtedly the system in Switzerland was conductive to the people's kind and generous natures. I felt certain that the care and compassion represented by the organizations in Geneva would be reflected in the politics and society of the Swiss.
These preconceptions were re-enforced for me by both our conversation with representatives from the Swiss operational headquarters of Médecins Sans Frontières (MSF) as well as the Red Cross tour. The presentation by a representative from MSF revealed that the humanitarian aid organization was funded almost entirely by private donations, with half of the overall budget coming from Swiss donors and another third coming from fund raising activities within the country. The speaker also pointed out that the budget for the Swiss MSF had doubled between 2004 and 2008, reflecting a huge increase in the amount and/or number of Swiss donors who contributed to the aid organization.
While we had discussed the significance of the Red Cross in terms of the overall humanitarian movement while in Paris at Médecins du Monde, I did not begin to fully appreciate its place in the international dialog regarding humanitarianism until our Red Cross tour. The Red Cross Museum uses powerful symbolic representation to present their ideas and history, which for me brought their stories to life. A small concrete cell allowed us to feel like isolated prisoners, simulated land mines in the floor reminded us how easily they could be mistaken for toys, and vast towers of index cards represented lost prisoners of war and their families' desperation. The history of the Red Cross is rooted in Switzerland, where it was founded by a Swiss businessman named Henri Dunant, and from which the Geneva Conventions were born. Due to my past experiences with Amnesty International and my interest in humanitarianism, the Geneva Conventions hold incredible importance to me. Learning about the role of the Red Cross and the Swiss in their creation further increased my satisfaction with the Swiss themselves.
The same night over dinner, my Swiss sister Justine lamented about her problems with health insurance. Neither Justine nor her sister, both teachers, she explained, have succeeded in finding a full time job, therefore each of them make only a portion of an average teacher's salary. Despite their shortage in funds, they still must pay for the mandatory health insurance, which at the most basic in Vaud costs about 280 francs per month. To get extra benefits, such as a private room or access to more diverse medications and remedies, they must pay even more per month.
Listening to Justine describe her situation- spending roughly 15-20% of her monthly salary on health insurance despite being young and healthy, I couldn't help but wonder if there was some sort of contradiction between what I had seen earlier at the Red Cross Museum and MSF and the situation with health insurance. Surely if the Swiss were so willing to donate to humanitarian causes abroad they would be willing to ensue that everyone in Switzerland had reasonable access to quality health care, I thought. Over the next few days I pursued more conversations with the Swiss of Vaud regarding health insurance and health care.
One older man I spoke with, an invalid who could no longer work for medical reasons, explained that the state provided him with a stipend of 2,000 francs per month- a little more than 2/3 of the monthly rent for his family home. While he had hoped to receive government assistance for medical insurance, which for the elderly is very high, he was turned down because he has a phone, electricity, an apartment, and other things that could be liquidated into cash if he was actually in need. He was not, according to the system, in need of any financial assistance.
An unnamed women I spoke to outside of the Migros in Nyon also had a few criticisms for the health care system in Vaud. She explained that the rich as well as the poor have the same insurance rates, and reminded me that in different cantons such as Geneva, the situation is completely different. Despite the fact that many insurance companies are private and ought to be competitive with each other and government insurance, she said, average workers who live on less than 4,000 francs per month were setting prices alongside bankers who take in over 200,000 francs per year. These high incomes, she believed, contribute to insurance companies making profits while still charging painfully high rates. Another man I spoke with regarding my second observation journal entry, Laurent, felt that the insurance rates in Vaud reflect Vaud's relatively high income, and explained that in a region with a lower income, insurance rates are also relatively low.

Interpretation:
These varied perspectives and experiences helped me form interpretations of the situations I had directly observed and indirectly learned about though conversations. The humanitarian reputation of Switzerland is undeniable- but what is questionable is the validity of this reputation. While the Swiss could be unusually compassionate and concerned with the health and wellbeing of all humans, the reputation could have also been created by the nation's simple and efficient neutrality. Neutrality, which has kept Switzerland out of wars that could have potentially destroyed the country, has also made it incredibly hospitable to international organizations of all kind, many of which focus on humanitarianism. It is possible that the reputation of the Swiss as a humanitarian nation could be created by the activities of organizations more so than the actual values of the population.
In addition, the way I perceived MSF's statement that most of their funding comes from private donors could have been incorrect. MSF admits that they limit the amount of funding they receive from institutions to less than 20%. If this is true, most of their budget would HAVE to come from donors whether the donors were usually generous or not. The doubling of the budget as well is hard to judge without considering the economic growth of the country over the last four years as well as donor trends in other MSF nations.
Health care in Switzerland is open to multiple interpretations as well. Mandatory health insurance as well as a choice between state or private insurance policies could be a sign of a population who values both the competitive marketplace as well as a minimum government standard. A concern for equality is also reflected in the requirement that insurance policies at a certain premium must cost the same for individuals of the same age group, regardless of their sex or state of health. For full time workers, this insurance may not be overly costly at all; it also may not be the responsibility of the health care system in Switzerland to react when full time work is difficult to find. We must also recognize the quality of even basic Swiss health care, which is some of the best in the world, and thus bound to be more expensive than lower quality care. While my initial observation suggested a possible contradiction between the image and reality of the Swiss in terms of health care, under closer inspection I can see that there may be no contradiction at all. In fact, I may have misinterpreted and mis-evaluated my original observation, due to both preconceptions as well as my sometimes overly sympathetic ear.

Evaluation:
Is there a contradiction between the humanitarian reputation of Switzerland and the health care system?
After a careful examination of my experiences and conversations, I feel that there is no contradiction between health care in Switzerland (Vaud specifically) and the humanitarian reputation. The health care system could be improved in some ways: subsidized insurance for low income and part time workers, requiring insurance companies to make their records public, or other strategies from neighboring cantons could be implemented to reduce costs for those without a banker's salary. In a way, however, these types of policies themselves would be contrary to the typical Swiss way, where everything has a price.
We must also keep in mind that the humanitarian reputation Switzerland carries stems mostly from Geneva and the organizations that reside in that canton, not necessarily from the people of Vaud. I take special note here of one interviewee, who explained that the health care system is more accessible in the canton of Geneva than in Vaud. Therefore, I believe the humanitarian reputation is not nearly as Swiss as I previously thought, and is in fact more specific to the canton of Geneva and the organizations present.
The idea of charity organizations and humanitarian aid that helps the poor with donations of food, money, education, etc, seems to run perfectly in line with the capitalist system in Switzerland. In Switzerland, market competition is utilized in hopes of increasing the choices and availability of insurance for the Swiss, and is complemented by state insurance. Charity donations and aid, rather than a state imposed tax or redistribution of wealth, are a free market way of dealing with the problems of poverty. Many Swiss make charitable donations to programs like MSF, which I believe shows to a certain degree that the Swiss believe in helping those who are unable to help themselves. With an average income of over $40,000/year and a history of independence, however, perhaps voters in Vaud believe that they are for the most part able to take care of themselves, and therefore not in need of strong state assistance. Curiously from a U.S. perspective, the way health insurance works is decided by Swiss voters rather than politicians and economists, and this brings up more questions that will be answered in my observation journal regarding direct democracy in Vaud.